Sexual function in reproductive-aged women following radiotherapy: a cross sectional study
Shimona Lai
A * , Genia Rozen B C D and Alex Polyakov B D
+ Author Affiliations
- Author Affiliations
A Monash Women’s, Monash Health, 246 Clayton Road, Clayton, Vic., Australia.
B Reproductive Services, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Vic., Australia.
C Gynaecology Research Unit, The University of Melbourne, Parkville, Vic., Australia.
D Melbourne IVF, Melbourne, Vic., Australia.
Sexual Health 18(5) 358-365 https://doi.org/10.1071/SH20227
Submitted: 31 December 2020 Accepted: 16 July 2021 Published: 8 November 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: While female sexual dysfunction post-radiation therapy has been previously described, much of the literature is focused on older, often postmenopausal, women; and neglects the experiences of younger populations. Our study aims to describe the changes in sexual functioning following radiotherapy among women of a reproductive age.
Methods: A cross-sectional survey was conducted on reproductive-aged women post-radiation therapy. Information on sexual frequency, pleasure, discomfort and habit was collected and compared to responses from healthy women of comparable ages.
Results: Reproductive-aged women post-radiotherapy experienced decreased pleasure, more discomfort and had less sexual activity than healthy controls. However, sexual habit was comparable.
Conclusions: Our findings illustrated that most domains of sexual function are negatively affected in our study population. Understanding the sexual sequelae of radiation therapy may help guide clinicians in counselling their patients and planning their future needs.
Keywords: cancer, quality of life, radiotherapy, reproductive health, sexual behaviours, sexual dysfunction, sexual function, sexual health.
References
[1] Baskar R, Lee KA, Yeo R, Yeoh K-W. Cancer and radiation therapy: current advances and future directions. Int J Med Sci 2012; 9 193–99.| Cancer and radiation therapy: current advances and future directions.Crossref | GoogleScholarGoogle Scholar | 22408567PubMed |
[2] Cancer Australia. 5-year relative survival 2020. Available at https://ncci.canceraustralia.gov.au/outcomes/relative-survival-rate/5-year-relative-survival
[3] Morris KA, Haboubi NY. Pelvic radiation therapy: between delight and disaster. World J Gastrointest Surg 2015; 7 279–88.
| Pelvic radiation therapy: between delight and disaster.Crossref | GoogleScholarGoogle Scholar | 26649150PubMed |
[4] Prasanna PGS, Stone HB, Wong RS, Capala J, Bernhard EJ, Vikram B, et al. Normal tissue protection for improving radiotherapy: where are the gaps? Transl Cancer Res 2012; 1 35–48.
[5] Citrin DE, Mitchell JB. Mechanisms of normal tissue injury from irradiation. Semin Radiat Oncol 2017; 27 316–24.
| Mechanisms of normal tissue injury from irradiation.Crossref | GoogleScholarGoogle Scholar | 28865514PubMed |
[6] Hofsjö A, Bohm-Starke N, Blomgren B, Jahren H, Steineck G, Bergmark K. Radiotherapy-induced vaginal fibrosis in cervical cancer survivors. Acta Oncologica 2017; 56 661–6.
| Radiotherapy-induced vaginal fibrosis in cervical cancer survivors.Crossref | GoogleScholarGoogle Scholar | 28084859PubMed |
[7] Cust MP, Whitehead MI, Powles R, Hunter M, Milliken S. Consequences and treatment of ovarian failure after total body irradiation for leukaemia. Br Med J 1989; 299 1494–7.
| Consequences and treatment of ovarian failure after total body irradiation for leukaemia.Crossref | GoogleScholarGoogle Scholar |
[8] Duncan FE, Kimler BF, Briley SM. Combating radiation therapy-induced damage to the ovarian environment. Future Oncol 2016; 12 1687–90.
| Combating radiation therapy-induced damage to the ovarian environment.Crossref | GoogleScholarGoogle Scholar | 27117319PubMed |
[9] Jensen PT, Froeding LP. Pelvic radiotherapy and sexual function in women. Transl Androl Urol 2015; 4 186–205.
| Pelvic radiotherapy and sexual function in women.Crossref | GoogleScholarGoogle Scholar | 26816824PubMed |
[10] Adams E, Boulton MG, Horne A, Rose PW, Durrant L, Collingwood M, et al. The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life. Clin Oncol 2014; 26 10–7.
| The effects of pelvic radiotherapy on cancer survivors: symptom profile, psychological morbidity and quality of life.Crossref | GoogleScholarGoogle Scholar |
[11] Mernone L, Fiacco S, Ehlert U. Psychobiological factors of sexual functioning in aging women – findings from the women 40+ healthy aging study. Front Psychol 2019; 10 546
| Psychobiological factors of sexual functioning in aging women – findings from the women 40+ healthy aging study.Crossref | GoogleScholarGoogle Scholar | 30918494PubMed |
[12] Thirlaway K, Fallowfield L, Cuzick J. The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 1996; 5 81–90.
| The sexual activity questionnaire: a measure of women’s sexual functioning.Crossref | GoogleScholarGoogle Scholar | 8901370PubMed |
[13] Atkins L, Fallowfield LJ. Fallowfield’s sexual activity questionnaire in women with without and at risk of cancer. Menopause Int 2007; 13 103–9.
| Fallowfield’s sexual activity questionnaire in women with without and at risk of cancer.Crossref | GoogleScholarGoogle Scholar | 17785035PubMed |
[14] Stead ML, Crocombe WD, Fallowfield LJ, Selby P, Perren TJ, Garry R, et al. Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders. Br J Obstet Gynaecol 1999; 106 50–4.
| Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders.Crossref | GoogleScholarGoogle Scholar | 10426259PubMed |
[15] Hatcher MB, Fallowfield L, A’Hern R. The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured interviews. Br Med J 2001; 322 76
| The psychosocial impact of bilateral prophylactic mastectomy: prospective study using questionnaires and semistructured interviews.Crossref | GoogleScholarGoogle Scholar |
[16] Kessel B, Nachtigall L, Plouffe L, Siddhanti S, Rosen A, Parsons A. Effect of raloxifene on sexual function in postmenopausal women. Climacteric 2003; 6 248–56.
| Effect of raloxifene on sexual function in postmenopausal women.Crossref | GoogleScholarGoogle Scholar | 14567773PubMed |
[17] Vistad I, Fosså SD, Kristensen GB, Mykletun A, Dahl AA. The sexual activity questionnaire: pychometric properties and normative data in a Norwegian population sample. J Womens Health 2007; 16 139–48.
| The sexual activity questionnaire: pychometric properties and normative data in a Norwegian population sample.Crossref | GoogleScholarGoogle Scholar |
[18] Wills C, Cherian S, Yousef J, Wang K, Mackley H. Total body irradiation: a practical review. Appl Radiat Oncol 2016; 2 11–7.
[19] Kingsberg SA. The impact of aging on sexual function in women and their partners. Arch Sex Behav 2002; 31 431–37.
| The impact of aging on sexual function in women and their partners.Crossref | GoogleScholarGoogle Scholar | 12238611PubMed |
[20] Gillespie BJ. Correlates of sex frequency and sexual satisfaction among partnered older adults. J Sex Marital Ther 2017; 43 403–23.
| Correlates of sex frequency and sexual satisfaction among partnered older adults.Crossref | GoogleScholarGoogle Scholar | 27115100PubMed |
[21] Fisher L. Sex, romance, and relationships: AARP survey of midlife and older adults: AARP knowledge management. 2010. Available at https://assets.aarp.org/rgcenter/general/srr_09.pdf
[22] Lodge AC, Umberson D. All shook up: sexuality of mid- to later life married couples. J Marriage Fam 2012; 74 428–43.
| All shook up: sexuality of mid- to later life married couples.Crossref | GoogleScholarGoogle Scholar | 22904574PubMed |
[23] Higgins JA, Mullinax M, Trussell J, Davidson JK, Moore NB. Sexual satisfaction and sexual health among university students in the United States. Am J Public Health 2011; 101 1643–54.
| Sexual satisfaction and sexual health among university students in the United States.Crossref | GoogleScholarGoogle Scholar | 21778509PubMed |
[24] Roels R, Janssen E. Sexual and relationship satisfaction in young, heterosexual couples: the role of sexual frequency and sexual communication. J Sex Med 2020; 17 1643–1652.
| Sexual and relationship satisfaction in young, heterosexual couples: the role of sexual frequency and sexual communication.Crossref | GoogleScholarGoogle Scholar | 32694066PubMed |
[25] Pedersen W, Blekesaune M. Sexual satisfaction in young adulthood: cohabitation, committed dating or unattached life? Acta Sociologica 2003; 46 179–93.
| Sexual satisfaction in young adulthood: cohabitation, committed dating or unattached life?Crossref | GoogleScholarGoogle Scholar |
[26] Littley MD, Shalet SM, Morgenstern GR, Deakin DP. Endocrine and reproductive dysfunction following fractionated total body irradiation in adults. QJM 1991; 78 265–74.
| Endocrine and reproductive dysfunction following fractionated total body irradiation in adults.Crossref | GoogleScholarGoogle Scholar | 2047520PubMed |
[27] Incrocci L, Jensen PT. Pelvic radiotherapy and sexual function in men and women. J Sex Med 2013; 10 53–64.
| Pelvic radiotherapy and sexual function in men and women.Crossref | GoogleScholarGoogle Scholar | 23387912PubMed |
[28] Dizon DS, Suzin D, McIlvenna S. Sexual health as a survivorship issue for female cancer survivors. Oncologist 2014; 19 202–10.
| Sexual health as a survivorship issue for female cancer survivors.Crossref | GoogleScholarGoogle Scholar | 24396051PubMed |
[29] Liavaag AH, Dørum A, Bjøro T, Oksefjell H, Fosså SD, Tropé C, et al. A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors. A therapeutic approach. Gynecol Oncol 2008; 108 348–54.
| A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors. A therapeutic approach.Crossref | GoogleScholarGoogle Scholar | 17996925PubMed |
[30] Krychman ML, Pereira L, Carter J, Amsterdam A. Sexual oncology: sexual health issues in women with cancer. Oncology 2006; 71 18–25.
| Sexual oncology: sexual health issues in women with cancer.Crossref | GoogleScholarGoogle Scholar | 17347586PubMed |
[31] Wallen K, Lloyd EA. Female sexual arousal: genital anatomy and orgasm in intercourse. Horm Behav 2011; 59 780–92.
| Female sexual arousal: genital anatomy and orgasm in intercourse.Crossref | GoogleScholarGoogle Scholar | 21195073PubMed |
[32] Das P, Cantor SB, Parker CL, Zampieri JB, Baschnagel A, Eng C, et al. Long-term quality of life after radiotherapy for the treatment of anal cancer. Cancer 2010; 116 822–9.
| Long-term quality of life after radiotherapy for the treatment of anal cancer.Crossref | GoogleScholarGoogle Scholar | 20041481PubMed |
[33] Ramirez-Fort MK, Rogers MJ, Santiago R, Mahase SS, Mendez M, Zheng Y, et al. Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part I defining the organ at risk for sexual toxicities). Rep Pract Oncol Radiother 2020; 25 367–75.
| Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part I defining the organ at risk for sexual toxicities).Crossref | GoogleScholarGoogle Scholar | 32322175PubMed |
[34] Shahhosseini Z, Gardeshi ZH, Pourasghar M, Salehi F. A review of affecting factors on sexual satisfaction in women. Mater Sociomed 2014; 26 378–81.
| A review of affecting factors on sexual satisfaction in women.Crossref | GoogleScholarGoogle Scholar | 25685081PubMed |
[35] Jia S-Z, Leng J-H, Sun P-R, Lang J-H. Prevalence and associated factors of female sexual dysfunction in women with endometriosis. Obstet Gynecol 2013; 121 601–6.
| Prevalence and associated factors of female sexual dysfunction in women with endometriosis.Crossref | GoogleScholarGoogle Scholar | 23635624PubMed |
[36] Michael A, O’Keane V. Sexual dysfunction in depression. Hum Psychopharmacol 2000; 15 337–45.
| Sexual dysfunction in depression.Crossref | GoogleScholarGoogle Scholar | 12404311PubMed |
[37] Morris L, Do V, Chard J, Brand AH. Radiation-induced vaginal stenosis: current perspectives. Int J Womens Health 2017; 9 273–9.
| Radiation-induced vaginal stenosis: current perspectives.Crossref | GoogleScholarGoogle Scholar | 28496367PubMed |
[38] Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2003; 56 937–49.
| Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer.Crossref | GoogleScholarGoogle Scholar | 12829128PubMed |
[39] Feichtinger M, Rodriguez-Wallberg KA. Fertility preservation in women with cervical, endometrial or ovarian cancers. Gynecol Oncol Res Pract 2016; 3 8
| Fertility preservation in women with cervical, endometrial or ovarian cancers.Crossref | GoogleScholarGoogle Scholar | 27468354PubMed |
[40] Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22 281–305.
| Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers.Crossref | GoogleScholarGoogle Scholar | 26759231PubMed |
[41] Thomtén J, Linton SJ. A psychological view of sexual pain among women: applying the fear-avoidance model. Women’s Health 2013; 9 251–63.
| A psychological view of sexual pain among women: applying the fear-avoidance model.Crossref | GoogleScholarGoogle Scholar | 23638781PubMed |
[42] Pazmany E, Bergeron S, Van Oudenhove L, Verhaeghe J, Enzlin P. Body image and genital self-image in pre-menopausal women with dyspareunia. Arch Sex Behav 2013; 42 999–1010.
| Body image and genital self-image in pre-menopausal women with dyspareunia.Crossref | GoogleScholarGoogle Scholar | 23605571PubMed |
[43] Moyneur E, Dea K, Derogatis LR, Vekeman F, Dury AY, Labrie F. Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia. Menopause 2020; 27 134–42.
| Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia.Crossref | GoogleScholarGoogle Scholar | 31688416PubMed |
[44] Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician 2000; 61 3090–6.
| 10839558PubMed |
[45] Ploch E. Hormonal replacement therapy in patients after cervical cancer treatment. Gynecol Oncol 1987; 26 169–77.
| Hormonal replacement therapy in patients after cervical cancer treatment.Crossref | GoogleScholarGoogle Scholar | 2433195PubMed |
[46] Decruze SB, Guthrie D, Magnani R. Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clin Oncol 1999; 11 46–8.
| Prevention of vaginal stenosis in patients following vaginal brachytherapy.Crossref | GoogleScholarGoogle Scholar |
[47] Robinson JW, Faris PD, Scott CB. Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 1999; 44 497–506.
| Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy.Crossref | GoogleScholarGoogle Scholar | 10348277PubMed |
[48] Berkey FJ. Managing the adverse effects of radiation therapy. Am Fam Physician 2010; 82 381–8.
| 20704169PubMed |
[49] Shankar A, Prasad N, Roy S, Chakraborty A, Biswas AS, Patil J, et al. Sexual dysfunction in females after cancer treatment: an unresolved issue. Asian Pac J Cancer Prev 2017; 18 1177–82.
| 28610399PubMed |
[50] Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-term endocrine and metabolic consequences of cancer treatment: a systematic review. Endocr Rev 2019; 40 711–67.
| Long-term endocrine and metabolic consequences of cancer treatment: a systematic review.Crossref | GoogleScholarGoogle Scholar | 30476004PubMed |
[51] Schmitt D, Shackelford T, Duntley J, Tooke W, Buss D, Fisher M, et al. Is there an early-30s peak in female sexual desire? cross-sectional evidence from the United States and Canada. Can J Hum Sex 2002; 11 1–8.
[52] Barr A, Bryan A, Kenrick DT. Sexual peak: socially shared cognitions about desire, frequency, and satisfaction in men and women. Pers Relatsh 2002; 9 287–99.
| Sexual peak: socially shared cognitions about desire, frequency, and satisfaction in men and women.Crossref | GoogleScholarGoogle Scholar |
